Acta Oto-Laryngologica最新文献

Backgrounds: Appropriate diagnosis and treatment of problems leading to balance dysfunction requires accurate information on the balance of the population at all ages, but little data are available.

Objective: To test the dynamic balance function in normal individuals and gather baseline data and performance characteristics across various age groups.

Methods: A total of 100 healthy subjects underwent Sensory Organization Tests (SOT), Motor Control Tests (MCT), Adaptation Tests (ADT), and Limits of Stability (LOS) using computerized dynamic posturography (CDP).

Results: Results showed that the scores for balance function and strategy in the SOT test decreased as the difficulty level increased. During the MCT test, the postural latencies of the young group's limbs were lower than those of the elderly and middle-aged groups (p < 0.05). In the ADT test, the swinging energy during ankle stretching varied significantly among the young, middle-aged, and elderly groups (p < 0.05). In the LOS test, the young group had significantly faster reaction times but higher average movement rates and maximum movement distance than older groups (p < 0.05).

Conclusion: Compared to other age groups, the elderly exhibit poor dynamic balance, slow recovery from balance disturbances, and limited exercise adaptability, and require more time to react to maintain balance.

Background: Sentinel lymph node biopsy (SLNB) is increasingly used in oral cavity squamous cell carcinoma (OCSCC) as a minimally invasive approach that may reduce overtreatment and morbidity compared to elective neck dissection (END).

Aim: This study evaluated the diagnostic performance of SLNB in clinically node-negative (cN0) OCSCC and its utility in mapping lymphatic drainage, particularly in advanced tumors.

Methods: A retrospective cohort of 57 cN0 OCSCC patients undergoing SLNB followed by completion neck dissection was analysed.

Results: In early-stage tumors (T1/T2), SLNB demonstrated 100% sensitivity and negative predictive value, with an occult metastasis rate of 23.8%. No false negatives were observed, and only one patient was upstaged. In T3/T4 tumors, sensitivity and NPV decreased to 55.6% and 60%. The false-negative rate (FNR), calculated as the proportion of false negatives among patients with histopathologically confirmed nodal metastases, was 44.4%. Contralateral or bilateral drainage occurred in 40% of well-lateralized advanced tumors, reflecting altered drainage with progression.

Conclusion: SLNB is a reliable staging tool in early OCSCC. In advanced disease, although diagnostic accuracy is reduced, it provides valuable information on atypical drainage pathways.

Significance: These findings support SLNB as an effective staging and lymphatic mapping tool, reinforcing its selective integration into OCSCC management.

Background: Partial auricle defects from lesion excision or trauma pose reconstruction challenges, often leading to cosmetic issues and psychological distress.

Objectives: To evaluate the effectiveness of single-stage repair of partial auricular defects using periauricular pedicled flaps, and to assess the efficacy and precautions associated with this technique.

Methods: A retrospective analysis of 29 patients (29 ears) with partial auricular defects 27 due to lesion excision and 2 due to trauma was conducted. Patients aged 5 to 75 years (mean age: 40.1), included 12 females and 17 males, with defects involving various auricular areas and sizes from 10 mm × 10 mm to 25 mm × 50 mm. Surgical techniques included local random flaps (12 cases), postauricular revolving door island flaps (8 cases), and a combination (9 cases). Follow-up lasted 6 to 24 months.

Results: All defects were successfully closed. Cosmetic outcomes were highly satisfactory, with restored contour and no significant deformities. Most cases healed without complications; two minor issues were resolved with short-term treatment. No major complications such as necrosis or infection occurred. Long-term outcomes were stable, with consistent healing.

Conclusion: Periauricular pedicled flaps provide an effective singel-stage solution for partial auricular defects, yielding favorable aesthetic outcomes and minimal complications, supporting its clinical adoption.

Background: Postoperative bleeding after tonsillectomy is a potentially serious complication. Cold techniques reduce bleeding risks, but hot techniques remain widely used, reflecting national variations in clinical practice.

Aims/objectives: This study aimed to investigate postoperative bleeding rates after tonsillectomy and their correlation with demographic factors and surgical and haemostatic techniques, using data from national tonsil surgery registries in Norway and Sweden.

Materials and methods: A prospective cohort study included 28,254 tonsillectomies (2017-2022), with patients completing a 30-day postoperative questionnaire. Data on indication for surgery, surgical and haemostatic technique and postoperative bleeding were analyzed using multivariate logistic regression.

Results: Postoperative bleeding was reported in 7.2% of the patients, with higher rates in Norway (8.1%) compared to Sweden (6.3%). A hot + hot technique significantly increased the bleeding risk (OR 3.64), while the cold + cold technique had the lowest rate. Patients aged 19-24 years and males had higher bleeding risks.

Conclusions and significance: The cold + cold technique significantly reduces postoperative bleeding, but the cold + hot technique remains the most utilized approach. Norway performed more surgeries in high-risk age groups and had less frequent use of the cold + cold technique compared to Sweden. Increased adoption of the cold + cold technique may improve outcome in tonsil surgery.

Background: The global aging population surge has turned Presbycusis (PC) into a major public health problem. Functional magnetic resonance imaging (fMRI) is pivotal for exploring the central mechanisms of hearing loss, offering insights into PC-related neural processes.

Aims: This paper reviews the latest fMRI applications in PC research, aiming to explore auditory processing mechanisms and the neurological bases of cognitive function, analyze functional connectivity abnormalities and compensatory mechanisms, and comprehensively assess PC's impact on brain structure and function via integration with diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS).

Material and methods: A literature review was performed, gathering and analyzing recent fMRI-based PC research, including studies on auditory processing, cognitive function, and combined use of multiple imaging techniques.

Results: Studies have identified auditory pathway abnormalities, cognitive neural network changes, and abnormal functional connectivity with compensatory mechanisms in PC patients. However, technical constraints, individual variability, and small sample sizes impede research progress.

Conclusions and significance: Despite current limitations, existing research paves the way for future studies. The integration of multimodal imaging and artificial intelligence holds promise for more precise and personalized PC diagnosis, treatment, and rehabilitation.

Background: Pediatric benign middle-ear lesions are rare, with diagnostic delays or errors being common.

Aim/objectives: To analyze clinical characteristics of benign congenital middle-ear neoplasms in children.

Materials and methods: In this retrospective study, we reviewed the clinical data of children with benign middle-ear neoplasms and assessed reasons for initial consultations, audiometry, lesion extent, surgical plans, complications, and prognosis.

Results: All nine included patients (two boys and seven girls) with confirmed diagnoses presented with moderate-to-severe conductive hearing loss. All patients underwent middle-ear neoplasm resection and tympanoplasty, revealing varying degrees of ossicular chain destruction intraoperatively. Neoplasms originated from the Eustachian tube and tympanic cavity in four and five patients, respectively. Postoperative pathology identified mature teratomas, kaposiform haemangioendotheliomas, hairy polyps, and choristomas in four, one, two, and two patients, respectively. No recurrences were observed at the 1-year follow-up. One patient experienced postoperative peripheral facial paralysis, which improved after facial-nerve decompression (House-Brackmann grade IV to II).

Conclusions and significance: Benign congenital middle-ear neoplasms are typically unilateral. Initial symptoms include failed hearing screenings and otorrhea. The recurrence rate is low, but functional reconstruction often requires a two-stage surgical approach.

Background: Continuous positive airway pressure (CPAP) is the standard treatment for adult obstructive sleep apnea (OSA), but adherence is often suboptimal. Surgical options, such as tonsillectomy, may be considered in selected patients.

Aims/objectives: To compare the effectiveness of tonsillectomy with lifestyle counseling in adult patients with OSA.

Material and methods: This randomized controlled trial included 29 patients with primarly mild to moderate OSA and BMI ≤ 35. Participants were randomly assigned to receive either lifestyle counseling (n = 17) or tonsillectomy (n = 12). In-laboratory polysomnography was performed at baseline and after one year to assess changes in OSA severity based on the apnea-hypopnea index (AHI).

Results: The tonsillectomy group showed a statistically and clinically significant reduction in AHI, resulting in a shift in average OSA severity from moderate to mild. In contrast, the control group showed no significant change, with OSA severity remaining at a moderate level on average.

Conclusions and significance: Tonsillectomy may be an effective treatment option for selected adult patients with mild to moderate OSA and no more than mild obesity. These findings support the role of tonsillectomy as a treatment alternative for patients non-adherent to conservative treatments, and may assist in individualized care of non-severe OSA.Trial registration: ClinicalTrials.gov Identifier: NCT00747890 (registered 2008-09-04).

Background: Bone conduction auditory implants offer an effective alternative for patients with conductive, mixed, or single-sided hearing loss by transmitting sound through skull vibrations, bypassing the outer and middle ear.

Objectives: This study aims to introduce and delineate a comprehensive surgical technique for the Cochlear^™ Osia^® 2 System, a groundbreaking development in active bone conduction auditory implants utilizing piezoelectric principles.

Materials and methods: Five participants with audiologically eligible indications for a bone conduction hearing implant underwent Osia^® 2 implantation. The outcomes were evaluated over a 3-month period.

Results: The new surgical technique minimized surgical scars with a short surgical time. It showed particularly significant benefits in challenging acoustic environments, showcasing an improvement even when noise was directed towards the device. This contrasts with previous findings on the BAHA Attract System, suggesting that Osia^® may offer enhanced auditory capabilities in noisy conditions.

Conclusion and significance: The presented surgical technique for Osia^® 2 implantation, characterized by a small incision and local anesthesia, proves to be a transformative approach. The method not only optimizes the potential of the piezoelectric Osia^® 2 implant but also addresses the shortcomings of previous implant generations, emphasizing aesthetic outcomes, streamlined procedures, and reduced operating times.

Background: Vestibular schwannoma (VS) is a benign, slow-growing tumor arising from schwann cells of the vestibulocochlear nerve. Despite its non-malignant pathology, its location in the cerebellopontine angle and lies close to the brainstem, leading to both neurological deficits and emotional strain. Microsurgical resection remains a primary treatment option, for large or symptomatic tumors. However, surgery and general anesthesia can also heighten patients' emotional distress.

Aims/objectives: To investigate the prevalence and clinical predictors of preoperative anxiety in patients undergoing microsurgical resection of vestibular schwannoma (VS).

Material and methods: In this retrospective cohort study, 404 adult patients who underwent elective VS resection between September 2019 and July 2024 were analyzed. Preoperative anxiety was assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A), with scores ≥8 indicating clinically relevant anxiety. Univariable and multivariable logistic regression analyses were performed to identify variables associated with anxiety.

Results: Among the 404 patients, 24.8% (n = 100) had preoperative anxiety (HADS-A ≥ 8). Multivariable logistic regression identified vertigo (OR: 1.800; 95% CI: 1.083-2.991; p = 0.023), facial paralysis (OR: 4.241; 95% CI: 1.417-12.688; p = 0.010), headache (OR: 1.833; 95% CI: 1.039-3.234; p = 0.036), and subjective hearing loss (OR: 5.070; 95% CI: 1.149-22.366; p = 0.032) as independent predictors of preoperative anxiety.

Conclusion and significance: Preoperative anxiety is common among VS patients and is significantly associated with vestibular and auditory symptoms. Vestibular dysfunction and subjective perceptions of hearing may be more relevant to emotional distress than objective audiometric thresholds, warranting tailored perioperative support.

Key points: Nearly one in four patients with vestibular schwannoma reported clinically relevant preoperative anxiety, underscoring the need for routine psychological screening before surgery.Vertigo, facial paresis, headache, and subjective hearing loss were key symptom-related risk factors for anxiety, suggesting that symptom type may be more informative than symptom count.Subjective hearing complaints, even without audiometric confirmation, were strongly linked to anxiety and should be considered during preoperative counseling and support planning.